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Neuro Flashcards

1
Q

Leg dermatomes

A 
L2 - mid thigh
L3 - over the top of the knee 
L4 - medial calf
L5 - lat calf
S1 - edge of dorsum foot

Then do stocking distribution

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2
Q

vibration sensation

A

Test on most distal bony prominence and assess when stops, work up if cannot feel

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3
Q

polyneuropathies that are predominantly motor

A

GBS, lead poisoning, Charcot Marie tooth

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4
Q

causes of sensory-motor peripheral neuropathy

A 
Metabolic causes:
• Diabetes (most common)
• hypothyroidism
• vitamin deficiencies such as B1, B6 and B12
• uremia
Toxic causes:
• alcohol (most common)
• chemotherapy agents
• antibiotics
• Lead  (predom motor)
Immune-mediated /inflammatory conditions:
• acute onset- GBS  (predom motor)
• chronic inflammatory demyelinating polyneuropathy (CIDP)
• Lambert-eaton / Myasthenia Gravis
• rheumatoid arthritis
• Sjogren's 
• SLE
• sarcoidosis
• ANCA positive vasculitis

Paraneoplastic causes,
• Solid organ malignancy such as lung cancer
• or paraproteinemia

Genetic
• Charcot marie tooth (predom motor)

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5
Q

Electrophysiology in peripheral neuropathy

A

Nerve conduction studies can distinguish between axonal and demyelinating causes

and if length-dependent

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6
Q

axonal vs demyelinating causes of peripheral neuropathy

A

distinguish with nerve conduction studies

Axon loss
• trauma / toxic / ischemic / metabolic / genetic conditions

Demyelination
• compressive neurop
• hereditary neurop
• acquired immune-mediated e.g. GBS and CIDP

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7
Q

Interpretation of Romberg’s test

A

If ataxic and Romberg positive- implies ataxia is sensory in nature (i.e. from loss of proprioception)

If ataxic and Romberg’s not positive- implies ataxia is due to cerebellar dysfunction

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8
Q

Next steps of investigation for peripheral neuropathy

A
  • Bedside tests for diabetes: CBG, urine dipsticks
  • Diabetic retinopathy w fundoscopy
  • Basic blood tests including antibodies
  • Nerve conduction studies
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9
Q

Features of charcot marie tooth

A

Generalised wasting, particularly distal - inverted champagne bottle
Weakness - high stepped gait/ foot drop
Reduced sensation

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10
Q

Is charcot marie tooth demylinating?

A

There are many types, some demylinating and some axonal

Type 1 is associated with demyelination

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11
Q

Inheritance of charcot marie tooth

A

Can be auto dom, recessive or X-linked

Most common is Type 1 which is auto dom

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12
Q

Causes of third nerve palsy

A

Congenital vs Acquired

Acquired

  • Vascular ischemia (commonly diabetes, hypertension)
  • Vasc abnormality like aneurysm (esp in PKD)
  • SOL
  • Inflammation / infection
  • Demylinating - MS
  • Post-op
  • Cavernous sinus thrombosis

Ophthalmoplegic migraine

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13
Q

third nerve palsy signs

A
  • Ptosis (paralysis of levator palpebrae superioris muscle)
  • “Down and out” occular deviation
  • Pupil becomes fixed and dilated/mydriasis (paralysis of sphincter pupillae)
  • Diplopia
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14
Q

Drug triggers for Myasthenia Gravis

A 
Aminoglycosides - Gent, Neomycin
Beta blockers
Cipro
D-penicillamine (for Wilson's)
Fluoroquinolones - cipro , Levo
Quinine
Magnesium
Statin
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15
Q

Lambert Eaton Vs myasthenia gravis

A

In LES:
• rare to have opthalmeplegia
• rare to have severe repiratory muscle weakness

  • but has autonomic dysfunction: dry mouth /metallic taste, constipation, and erectile dysfunction
  • Fatigue IMPROVES with exercise in LE
  • LEMS voltage gated calcium channel
  • MG AChR
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16
Q

Features of myotonic dystrophy

A

Most common adult onset muscular dystrophy
Auto Dom, shows anticipation
CTG repeat mutation

Frontal balding
Cataracts
Bilat ptosis
Facial weakness
Testicular atrophy
Arrythmia
Reduced IQ
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17
Q

Differential of bilat ptosis

A
  • MG
  • Muscular dystrophies (Myotonic, Occulopharyngeal)
  • Chronic progressive external opthalmeplegia
  • Congenital
  • Bilat Horner’s
  • Syringomyelia
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18
Q

Arm dermatomes

A

C5 - lat upper arm
C6 - lat lower
C6 specifically median nerve - Lat (thumb) edge of hand
C7 - middle finger
C8 specifically ulnar nerve - medial edge (little finger)
C8 - medial lower arm
T1 - medial upper arm

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19
Q

Jaw jerk reflex

A

Tests CN V - trigeminal
When abnormal, with upper motor neuron lesions, there is a hyperactive or repeating reflex
(past test says you don’t feel anything normally)

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20
Q

CN for facial expression

A

CN 7 - facial

can test strength too, by attempting to pull apart

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21
Q

cough reflex

A

starts with stimulation of irritant receptors with afferents in the vagus nerve (CN X)

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22
Q

Specific sign of ALS

A

first dorsal interosseous muscle wasting ( thenar eminence ) compared to the hypothenar

AKA split hand sign

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23
Q

MND with only lower motor neuron signs

A

Spinal muscular atrophy (SMA) - autosomal recessive
Kennedy disease - X-linked recessive
Motor neuropathy with conduction block - acquired and treatable

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24
Q

What is the difference between fasciculation and fibrillation?

A

Both can be picked up on EMGs

Fibrillations are action potentials of individual fibres
Fasciculation is the summation of them all.. and are VISIBLE

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25
Q

signs and symps of MND

A

Rapid and aggressive asymmetrical disease process involving upper and lower motor neurons

May have behavioral / cognitive dysfunction frontotemporal dementia

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26
Q

three key features of MND

A

Weakness
Fasciluations
Wasting

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27
Q

Management of MND

A

Full mdt, dietician, SALT, specialist nurse, resp function monitoring

NIV, gastrostomy

Riluzole has small effect in prolonging survival

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28
Q

What treatment for MND extends life longest?

A

NIV extends 7 m

Riluzole extends 3m

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29
Q

Claw feet and motor sensory neuropathy

A

Charcot Marie tooth

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30
Q

Syncope differentials

A

Vasovagal
• Postural hypotension
• Micturition syncope
• Anxiety

Cardiac
• Arrhythmia
• AS
• HOCM

Respiratory
• PE

Neurological
• Seizures (?TS etc)
• TIA / stroke
• Lack of sleep
• Autonomic dysfunction (DM / Parkinson’s / MSA)
• ICH / SOL
• Meningitis etc

Drugs
• Alcohol
• Withdrawal / OD

Endocrine
• Hypoglycaemia
• Diabetic autonomic neuropathy
• Addison’s
• Electrolyte disturbance
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31
Q

Eye examination in Parkinson’s

A

Myerson’s sign / glabellar tap sign - tap between eyebrows and unable to resist blinking - early sign

Nystagmus - multisystem atrophy

Vertical gaze palsy (especially downgaze) - progressive supranuclear palsy

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32
Q

causes of cerebellar dysfunction

A
  • MS or MSA
  • Alcohol (and other drugs)
  • Vascular - Posterior circulation stroke
  • Inherited (ataxic telangiectasia, Friedreich’s ataxia) Inflammatory (Miller Fisher), Infectious (HIV, syphilis, CJD)
  • SOL
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33
Q

Syncope twitch Vs seizures

A

Syncope fall flaccid, random twitching, rapid recovery
Seizures tend to be rigid and more repetitive movement

Incontinence isn’t a great differentiator
Tongue biting particularly side or back are indicative

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34
Q

Red flags of syncope-

A

unprovoked or during exercise
murmur
family history

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35
Q

Key features of Myasthenia gravis history

A

Fatigability

Ptosis that gets worse during the day

Intermittent double vision , or changes -and DRIVING

Chewing getting worse by end of meal

Head drop

Brushing/washing hair etc

Co existing autoimmune

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36
Q

Criteria indicating potential myasthenic crisis

A
  • FVC < 20 or progressive decline
  • Can’t complete sentences
  • Can’t control their own secretions
  • Can’t lift head off pillow

….all require ICU assessment early

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37
Q

What can worsen myasthenia gravis?

A

Drugs gent,

BASIC LM in caution

Beta blockers
Aminoglycosides - Gent, Neomycin
Statins
Iodine
Calcium channel blockers
Lithium
Mg
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38
Q

epilepsy advice for patients

A
  • Don’t take baths,
  • If you swim, go with someone else
  • Don’t use heavy machinery
  • Pregnancy and medications
  • Driving - 6 months if normal EEG, or 12m, or 5 years if HGV driver
  • Offer support from Epilepsy Society, specialist nurses and Letter for employer
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39
Q

spasticity vs rigidity

A

both increased tone, but spasticity is velocity-dependent

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40
Q

What are the functions of the facial nerve

A

“face, ear, taste, tear”

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41
Q

Causes of Bell’s Palsy

A

Likely related to HSV

More likely in pregnancy, diabetes

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42
Q

Mx of Bell’s Palsy

A
  • Prednisolone within 72 hours of onset improves outcomes
  • plus aciclovir if severe
  • Artificial tears
43
Q

Causes of unilateral ptosis

A

• IIIrd nerve palsy
—>Down and out eye + fixed dilated pupil
• Horner’s syndrome
—>Ptosis + anhidrosis + miosis
• Myaesthenia Gravis
—>Bilateral facial weakness + proximal weakness with fatiguability + weak voice
• Congenital

44
Q

Examination for myasthenia gravis

A
  • Count as high as you can on one breath (<15 is bad)
  • Fatigued upward gaze
  • Ab- and adduct arms then do it 20X and see if weaker
  • Same with head
45
Q

Horner’s V third nerve palsy

A

Both ptosis
• Horners is Miosis (Constricted Pupil) with anhydrosis
• Third nerve is Midriasis and down and out

46
Q

Causes of third nerve palsy

A
  • Idiopathic
  • Vascular -diabetes, ichaemic, anneurysm
  • Space occupying lesions
  • Autoimmune disorders such as myasthenia gravis
  • Cavernous sinus - tumour, thrombosis

If involves PUPIL it’s SURGICAL (i.e. cavernous

47
Q

Cerebellar syndrome causes

A
  • Paraneoplastic
  • Alcoholic cerebellar degeneration
  • Sclerosis (multiple)
  • Tumour (posterior fossa SOL)
  • Rare (Friedrich’s and ataxia telangiectasia)
  • Iatrogenic - Phenytoin
  • Endo -hypothy
  • Stroke (brain stem vascular event)
48
Q

Classical history of cavernous sinus thrombosis

A
  • Young women, recently started the Pill / pregnant
  • persistent headache (can be sudden/gradual/diffuse/localised)
  • 40% have seizure within 24h
  • Reduced GCS and focal symps are common

CT venography

49
Q

Headache with autonomic features - tearing, drooping, nasal congestion, rhinorrhoea

A

Cluster headache

  • or swollen eyelid, pain around one eye, nasal congestion or rhinorrhoea
  • subcutaneous or nasal triptan
  • short burst O2
50
Q

Examination findings of myotonic dystrophy

A

• bilat ptosis, frontal balding, long face
• Myotonia (impaired relaxation) ask to grip hand then release
• wasting/weakness/areflexia of distal muscles
• Percussion myotonia: percuss thenar eminence and watch for involuntary thumb
flexion

51
Q

Multiple Sclerosis diagnosis

A
  • Hx separated by time and space
  • Visual evoked potentials
  • LP: oligoclonal IgG bands
  • MRI: periventricular white matter plaques
52
Q

Management of Multiple sclerosis

A
  • MDT
  • OT/PT
  • Walking aids
  • Symptom-focused (e.g. laxatives, opthal input, antidepressents, ED treatment etc)

Acute attacks
• IV methylpred (shortens attacks)

DMARDs
• if more than one relapse/year
• Interferon-beta (reduces relapse rate)

53
Q

peri-oral fasciculation

A

perioral fasciculations are almost pathognomonic for Kennedy’s disease
X-linked disease, slow progression

(weakness, wasting and fasciculations, like MND but only LMN)

54
Q

Horner’s causes

A

Central TRUNK + ARMS + FACE
• brain stem - ms stroke
• Spinal cord- syringomyelia

Pre-ganglionic FACE only
• Neck - Pancoast’s tumour, Aneurysm

Post-ganglionic no sweating
• Herpes Zoster

55
Q

Holmes–Adie (myotonic) pupil

A

• Moderately dilated pupil
• Sluggish reflex
• Reduced /absent ankle /knee
…Benign, reassure

56
Q

Young patient with TIA differentials

A
  • Hypoglycaemia
  • Migraines
  • Todd’s paresis
  • MS if relapsing remitting
  • SOL
  • Antiphospholipid (anti-cardiolipin Ig)
  • Valvular heart disease
  • Takayasu arteritis (pulseless)
  • Subacute bacterial endocarditis
  • Cerebral vasculitis
  • Sickle Cell
  • DVT ?paradoxical embolism
57
Q

Signs of raised ICP on examination

A
  • Reduced GCS
  • Papilloedema
  • Reduced visual fields
  • Unilateral ptosis or third and sixth nerve palsies
58
Q

Epilepsy counseling in pregnancy

A
  • If seizure-free before conception , likely to remain so
  • Most have normal pregnancies
  • Some anti eps may have a low risk, but inadequate seizure control is likely higher risk - aim for lower appropriate dose
  • Valproate is contraindicated in preg ( birth defects and developmental disorders, cardiac+NTD ) so only if really necessary
  • Lamotrogine effectiveness may be reduced by oestrogen contraception
  • Risks of Status to m+b - more common in preg due to preg + sometimes changing meds , but also reg repeated seizures carries risk (esp tonic-clonic)

• Remember folate replacement

59
Q

Features of hemiplegic migraines

A
  • Hx of migraines(!)
  • Not specific to vascular territory
  • May develop over minutes-30mins
  • Less common in elderly
  • Recurrent
60
Q

Stroke and Seizures

A
  • 4% of patients with stroke will have a seizure
  • More likely in haemorrhagic stroke
  • Likely wont develop post-stroke epilepsy
61
Q

Aphasia in stroke

A
  • 97% will have assx R-sided hemiplegia
  • The others will be R-dominant, likely L handed

If L-sided hemiplegia and Aphasia ?conversion syndrome

62
Q

Crescendo TIA differential

A

Amyloid Spells

  • stereotyped, recurrent, transient neurological episodes of paraesthesias, numbness or weakness
  • Old, hypertensive
  • Onset over seconds to minutes, then resolves
  • Respond to Valproate
63
Q

Vascular Parkinsonism

A
  • Predominant lower limb symptoms (unlike idiopathic)
  • Shuffling or freezing gait
  • Bilat mild tremor
64
Q

Parkinson’s medication counselling

A
  • Nausea / Vomiting
  • excessive sleepiness, hallucinations, and impulse control disorders - more likely with MOA then L-Dopa
  • COMT inhibitors get conf/hallucinations
  • MAOb cause postural hypotension
65
Q

?Parkinson’s management

A
  • Refer to PD specialist
  • Order CT
  • Don’t start Levo
  • Stop any drugs that might have caused it (but speak to MH if it’s antipsych etc)
  • Give leaflets!
66
Q

Treatment options with Parkinson’s

A
  • Levo dopa
  • MOAb inhibitors
  • Dopamine agonist
  • Can use Direct Brain Stimulation
  • Apomorphine (non-selective dopamine agonist, pump)
67
Q

Brown-Sequard Syndrome

A
  • Ipsilateral hypertonia, hyperreflexia, weakness, loss prop and vibration
  • Contralateral loss of pain and temp
68
Q

Causes of Brown-Sequard Syndrome

A
  • Demyelination
  • Trauma
  • Spinal cord tumours
  • Longitudinal myelitis
69
Q

Which nerve for wrist drop?

A

Radial nerve

C5 through T1 nerve roots

70
Q

Causes of wrist drop

A
  • Compressive nerve entrapment = “Saturday night palsy” is a commonly seen when the radial nerve is acutely compressed at the spiral groove
  • Stab wound jsut below clavicle (posterior brachial plexus)
  • Humeral fracture (radial groove in lat border)
  • Persistent injury from using crutches, or leaning on elbows
  • Lead poisoning
  • Thiamine deficiency (beriberi)
  • Limb-onset amyotrophic lateral sclerosis
  • Hereditary neuropathy with pressure palsies (HNPP)
71
Q

Magement of wrist drop

A
  • Depends on cause… 70% conservatively Mx
  • Splint
  • Could consider surgery
  • Likely 2-4 months to heal
72
Q

Differentials for asymmetric spastic paraparesis

A

Myelopathy

  • Trauma (disc prolapse- most common)
  • Ischaemia (spinal infarct)
  • Inflammation (Transverse Myelitis, multiple sclerosis)
  • Infection (HIV, Varicella)
  • Neoplasia
  • Metabolic / nutritional disorders (B12, Copper def)
  • Hereditary (hereditary spastic paraparesis)
73
Q

Asymmetric sensory change with proximal muscle weakness

plus reduced tone/reflexes

A

Likely inflammatory neuropathy (CSF raised protein normal cell count)
• GBS
• Chronic inflammatory demyelinating polyneuropathy

Common causes of polyneuropathy less likely here (like diabetes, alcohol, hypothy) as they are length-dependent

74
Q

Indications for CT prior to LP

A
  • Focal neurology
  • Reduced GCS
  • Papilloedema
75
Q

Syndromes associated with retinitis pigmentosa

A
  • Usher syndrome - commonest cause of deaf–blindness in the UK (can be auto dom/rec/X-linked, or spontaneous in 30%)
  • Alport’s syndrome - hearing loss, glomerulonephritis
76
Q

What would make a diagnosis of immune-mediated peripheral neuropathy more likely?

A

More likely to be:
• Non-length dependent (i.e. starting in hands, trunk or face)
• Assx with signif sensory ataxia
• Asymmetrical
• CIDP may have waxing and waning symptoms
• May be Assx w inflammatory arthopathy, rashes, sicca symptoms (RA, SLE, Sjogren’s)
• Usually demyelinating

77
Q

Differentials for Chorea-type movements (random and non-patterned)

A

Acutely:
• Hyperglycaemia
• Vascular - usually asymmetric: e.g. subthalamic nucleus causing hemiballismus

Immune mediated:
• SLE
• Sydenham chorea (Group A Strep, but rare)

Genetic
• Huntington’s (most common)

78
Q

Proximal symmetrical reduced power

Normal reflexes, tone, reflexes, coordination

A
  • Either Neuromuscular junction e.g. Myasthenia Gravis
  • or myopathy
  • AChR antibodies
  • neurophysiological would show reducing action potentials in NMJ
79
Q

Management of myasthenia gravis

A

if acutely
• ?Crisis- then ABCDE, get FVC and consider ITU
• IVIG / plasma exchange

Sub-acutely:
• Pyridostigmine (helps symps but not prog)
• CT for ?thymoma which would be resected, and improve symps
• Immunosuppressive Tx like steroids, azathioprine, mycofenalate - may have paradoxical “Steroid dip”, so titrate, sometimes in hosp

80
Q

Third nerve palsy involving pupil vs not

A

if pupil involved, more likely to be Surgical cause

  • Commincating posterior artery aneurysm
  • Cavernous sinus pathology
81
Q

Management of Freidrech’s ataxia

A

• Diagnosis via genetic testing but rule out things like B12 or E, and MRI brain/spine

  • Regular ECGs and echos due to arrythmia’s / cardiomyopathy
  • Supportive care w physio / OT

(Auto recessive)

82
Q

Occular vs generalised Myasthenia Gravis

A

If limited to occular, closely monitor for two years, as if iit is going to become generalised , likely to be then

83
Q

What are the CNS complications of HIV?

A 
• meningitis from tuberculosis
or when the CD4 count is much lower:
• toxoplasmosis
• cryptococcal
• meningitis 
• CMV disease

CD4 <50
• Malig (particularly primary CNS lymphoma)

84
Q

Management of TIA

A
  • Exclude mimics
  • Start 300mg Aspirin
  • Refer to stroke within 24h
  • If strok >7d ago then referral within 7d
  • If bleeding disorder/anticoag then CT
  • Don’t use ABCD2 to inform referral time!
  • Don’t drive until seen specialist
  • Inform about symps to look out for
85
Q

Scoring system for TIA

A

ABCD2
DON’T USE TO INFORM URGENCY OF REFERRAL as per NICE

• Age ≥ 60 years
• BP ≥ 140/90 mmHg
• Clinical features
------> Unilateral weakness+2
------> Speech disturbance without weakness+1
• Duration 
------> <10m 0
------> 10-59m +1
------> ≥ 60m +2
• History of diabetes

0-3 points: Low Risk
• 90-Day Stroke Risk: 3.1%

4-5 points: Moderate Risk
• 90-Day: 9.8%

6-7 points: High Risk
• 90-Day: 17.8%

86
Q

ABCD2 score interpretation

A

DON’T USE TO INFORM URGENCY OF REFERRAL as per NICE

0-3 points: Low Risk
• 90-Day Stroke Risk: 3.1%

4-5 points: Moderate Risk
• 90-Day: 9.8%

6-7 points: High Risk
• 90-Day: 17.8%

87
Q

Anticoagulation after stroke / TIA

A

If AF: Aspirin for 2 weeks then Warfarin

If metalic valve replacement: Aspirin for ONE week then Warfarin

88
Q

Classic Hx of tension headaches

A
  • usually bilateral
  • pressing/tightening
  • lasting min-dats
  • Not assx with N/V or aggrevated by daily living
  • May have pericranial tenderness

Simple analgesia
Identify assx stress, mood, chronic pain and sleep disorders

89
Q

Classic Hx of cluster headaches

A
  • unilateral
  • associated tearing, congestion, fullness to ear, eyelid oedema
  • can be pulsatile/boring/burning/pressure
  • lasts 15-180 mins
  • restless/agitated
  • can be circadian / triggered by things like alcohol,smell, physical exertion
90
Q

Cluster headache management

A
  • subcutaneous or nasal triptan
  • Do not offer paracetamol, NSAIDs, opioids, ergots or oral triptans for the acute treatment of cluster headache
  • Offer short burst oxygen therapy
  • Avoid triggers and avoid med overuse
91
Q

Management of essential tremor

A

Conservative - do nothing
• Alcohol?

Medical
• Propranolol - caution in asthma
• Primidone (antiepileptic) but can cause drowsiness

Surg in severe:
• thalamotomy
• thalamic deep brain stimulation

92
Q

Drug-induced neuropathy

A
  • Alcohol
  • Amiodarone
  • Statins
  • Chemo agents (60% of patients on chemo will get neuropathy)
  • Isoniazid, Ethambutol, Metronidazole
  • Immunosuppressant drugs
  • NRTIs
  • L-Dopa
93
Q

Mx after Subarachnoid haemorrhage

A
  • Address hypertension, smoking and excessive alcohol
  • Calcium antagonists Nimodipine reduce vasospasm
  • neurosurgical clipping and endovascular coiling
94
Q

Cubital tunnel syndrome prognosis

A

(Ulnar distribution)
Up to 50% of people get better with conservative, non-surgical treatment

The recurrence rate following surgical decompression is 12%

95
Q

Sign for ulnar nerve damage

A

Wartenberg’s sign
• involuntary abduction of the fifth (little) finger
• caused by unopposed action of the extensor digiti minimi

Froment’s sign
• Pinch grip between thumb and index
• Power of adductor pollicus of the thumb, which is innervated by the ulnar nerve

96
Q

Foot drop nerve

A

Common peroneal nerve

  • Weakness on the everting foot
  • Inability to extend the toes
  • Paraesthesia over the dorsum of the foot
97
Q

Association of carpal tunnel syndrome

A

Usually idiopathic (median nerve)

Can be assx with
• Overuse
• Trauma
• Pregnancy
• Diabetes
• Hypothyroidism
• CKD
98
Q

Carpal tunnel prognosis

A

1/3 resolve without treatment in 6 months

Another study found untreated at 2 years:
• 50% resolved
• 25% stable
• 25% worsened

0-12% recurrence after carpal tunnel decompression

99
Q

Lambert-eaton syndrome / cancer

A
  • autoimmune attack against the P/Q subtype of voltage-gated calcium channels
  • Also found on SCLC - so ?body makes them to attack cancer
  • Cancer (typically SCLC) is found within four years in virtually all cases
100
Q

Lamber-Eaton syndrome presentation

A
  • Proximal myopathy over months-years
  • waddling gait and difficulty with raising the arms.
  • Sometimes ptosis, chewing/swallowing difficulties
  • Autonomic symptoms - dry mouth, impotence and postural hypotension may be seen
  • Strength may improve initially on exercise but then lessens as exercise is sustained
101
Q

Causes of proximal myopathy

A

Endocrine
• Thyroid
• Cushing’s

Drug
• alcohol
• statins
• steroids

Inflammatory
• dermatomyositis//polymyositis (symmetrical, raised CK)
• inclusion body myositis (asymmetrical)

Cancer
• Lambert eaton
• Paraneoplastic - anti-Hu

Neurological
• GBS/CIDP
• myasthenia gravis

Causes without true weakness
• polymyalgia rheumatica
• fibromyalgia

102
Q

Presentation of inclusion body myositis

A
  • auto recessive or sporadic inflammatory myopathy
  • Mostly >50yr
  • Proximal myopathy (often asymmetriical)
  • reduced reflexes
  • dysphagia in 50%
  • Fatigue
  • resp muscles usually spared
103
Q

Multiple sclerosis prognosis

A

• around 5 to 10 years lower than average

104
Q

parkinson’s examination

A

Bradykinesia
• tap fingers as large and as fast as you can
• toe tapping

Rigidity
• tone in arms - particular in wrist - feeling resistance
• do it while tapping
• same with leg
• cogwheel is only with tremor superimposed

Tremor
• rest tremor
• postural tremor (outstretched)
• Kinestic tremor (just back and forth finger to nose) don’t go too fast

Gait and balance
• standing without arms
• walking
• balance

Other
• functional assessments (that’s the treatment criteria so v important)
•	Vertical eye movements (PSP)
•	Cerebellar and L/S BP (MSA)
•	Cognitive (lewy-body)

PACES (13 decks)

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